| NPI | 1396898227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904006423) |
| Additional Taxonomies | 104100000X Social Worker (Licence: VA 0904006423) |
| 106H00000X Marriage & Family Therapist (Licence: VA 0904006423) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2007-09-14 |