| NPI | 1811103468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: KY KY-178) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: SC 1213) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2007-07-08 |