| NPI | 1619936770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: KY 0307LCSW) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KY 0408CADC) |
| 106H00000X Marriage & Family Therapist (Licence: KY 0095LMFT) | |
| Enumeration Date | 2006-03-18 |
| Last Update Date | 2012-01-12 |