| NPI | 1972580348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 4029) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KY 0570) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2007-07-08 |