| NPI | 1013105576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DE Q1-0000893) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: DE Q1-0000893) |
| 106H00000X Marriage & Family Therapist (Licence: DE Q1-0000893) | |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2007-10-10 |