| NPI | 1295823912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C002115) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 3350) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2007-07-08 |