| NPI | 1689825671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: KY 1436) |
| Additional Taxonomies | 101Y00000X Counselor |
| 103T00000X Psychologist | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2020-11-05 |