| NPI | 1750303475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KY 119) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IN 34003127) |
| 106H00000X Marriage & Family Therapist (Licence: VA 0717000269) | |
| 101YM0800X Counselor, Mental Health (Licence: KY 103679) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2016-06-05 |