| 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 |