| NPI | 1417965781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW 179) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW00004911) |
| 106H00000X Marriage & Family Therapist (Licence: ID LMFT 3089) | |
| 106H00000X Marriage & Family Therapist (Licence: WA LF00001127) | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2007-07-08 |