| NPI | 1780609636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WI 321-124) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 1020-123) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2008-01-28 |