NPI | 1407951544 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 12105) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 106) |
Enumeration Date | 2006-09-13 |
Last Update Date | 2007-07-08 |