| NPI | 1780702910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY KY-994) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KY KY-0364) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2018-06-21 |