| NPI | 1831125780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 0419) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KY KY 0419) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2007-08-24 |