| NPI | 1336206671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 892-123) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 252-125) |
| 106H00000X Marriage & Family Therapist (Licence: WI 122-124) | |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2010-01-25 |