| NPI | 1205074671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL 702) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL 532) |
| Enumeration Date | 2009-01-23 |
| Last Update Date | 2009-01-23 |