| NPI | 1023013174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: IA 05899) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 0378) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2013-08-12 |