| NPI | 1851317630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KY 0172) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KY 131) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2014-11-06 |