| NPI | 1780901983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KY 106719) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KY 09-013) |
| Enumeration Date | 2010-04-27 |
| Last Update Date | 2022-07-21 |