| NPI | 1033578109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL 13439) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2016-02-18 |
| Last Update Date | 2019-05-24 |