| NPI | 1487676508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 2296) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WI 248) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2012-01-06 |