| NPI | 1114116027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IA 01319) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IA 00150) |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2007-10-16 |