| NPI | 1124465620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 1071-123) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 610-125) |
| 106H00000X Marriage & Family Therapist (Licence: WI 87-124) | |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2014-03-19 |