| NPI | 1811931736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 927) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: LA 872) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2011-02-15 |