| NPI | 1154421550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 575-123) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 575-123) |
| 103T00000X Psychologist (Licence: WI 435-124) | |
| 106H00000X Marriage & Family Therapist (Licence: WI 435-124) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2010-07-23 |