| NPI | 1013073022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WI 4018-123) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WI 545-124) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2007-07-08 |