| NPI | 1124030770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 1501-123) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WI 485-124) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2019-04-10 |