NPI | 1942424718 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW1678) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL MT1190) |
Enumeration Date | 2007-04-12 |
Last Update Date | 2012-08-14 |