| NPI | 1275702029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C001636) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 437) |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2008-02-26 |