| NPI | 1053453340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 698-123) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WI 209-124) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2010-09-23 |