| NPI | 1144351297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR 4144) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2009-02-20 |