| NPI | 1073575494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 001011) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS 0684) |
| 106H00000X Marriage & Family Therapist (Licence: KS 0150) | |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2007-07-08 |