| NPI | 1063595098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 7118299-3502 CSW) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCS22727) |
| 1041C0700X Social Worker, Clinical (Licence: CA 22727 LCSW) | |
| 1041C0700X Social Worker, Clinical (Licence: NV 117-C LCSW) | |
| 106H00000X Marriage & Family Therapist (Licence: NV 0275 MFT) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2009-11-17 |