| NPI | 1295784064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WI 2865) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WI 281) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2009-04-28 |