| NPI | 1902847023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: KS 1290) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KS 031) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2013-01-22 |