| NPI | 1932108990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW560) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL MT160) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2015-06-02 |