| NPI | 1104357094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041S0200X Social Worker, School (Licence: MD 18182) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: DC LG101980) |
| 106H00000X Marriage & Family Therapist (Licence: DC LMFT000088) | |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2017-03-23 |