| NPI | 1508013194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 0620) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KS lcmft145) |
| Enumeration Date | 2008-08-26 |
| Last Update Date | 2012-07-10 |