| NPI | 1609849025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL 0142) |
| Additional Taxonomies | 104100000X Social Worker (Licence: FL 0250) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2014-01-07 |