| NPI | 1679774590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IN 39000951A) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: KY 0038) |
| 106H00000X Marriage & Family Therapist (Licence: IN 35001012A) | |
| 106H00000X Marriage & Family Therapist (Licence: KY 0261) | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2007-07-08 |