| NPI | 1639226921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IA 00068) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 08876) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2014-06-06 |