| NPI | 1679783757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 3702) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC00300520) |
| 106H00000X Marriage & Family Therapist (Licence: VA 0717000618) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2007-07-08 |