| NPI | 1376504951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 104100000X Social Worker (Licence: IA 01241) |
| 1041C0700X Social Worker, Clinical (Licence: IA 01241) | |
| 106H00000X Marriage & Family Therapist (Licence: IA 00003) | |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2012-03-28 |