| NPI | 1639286552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 1722 123) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WI 284 124) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2007-07-09 |