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 |