| NPI | 1871560540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WI 454124) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2014-08-18 |