| NPI | 1770916686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 7994392-3502) |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2013-08-14 |