| NPI | 1467697383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904013065) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801098018) |
| 1041C0700X Social Worker, Clinical (Licence: TN 5062) | |
| 1041C0700X Social Worker, Clinical (Licence: NC C018665) | |
| 106H00000X Marriage & Family Therapist (Licence: VA 0717002153) | |
| Enumeration Date | 2008-12-05 |
| Last Update Date | 2025-06-24 |