| NPI | 1114033271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MA 93) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 200685) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2009-02-09 |