| NPI | 1912657008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KY 275560) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2023-01-24 |