| NPI | 1578671640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: KY 845) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KY 0336) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2014-06-12 |