| NPI | 1306864848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW523) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL MT370) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2007-07-08 |