| NPI | 1437196615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IA 000324) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: IL 180005090) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2011-02-04 |