| NPI | 1811983497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MD 06363) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: TX 04255) |
| 106H00000X Marriage & Family Therapist (Licence: MD LCM118) | |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2007-07-08 |