| NPI | 1285618561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 1298543501) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 1298543501) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2009-08-21 |