| NPI | 1942302591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NM C-07339) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NV LCSW2566C) |
| Enumeration Date | 2006-09-03 |
| Last Update Date | 2016-09-06 |