NPI | 1912147299 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WY LMFT-148) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: WY LMFT-148) |
172V00000X Community Health Worker (Licence: WY LMFT-148) | |
Enumeration Date | 2009-02-26 |
Last Update Date | 2013-09-27 |