| NPI | 1942574793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 103TR0400X Psychologist, Rehabilitation | |
| Enumeration Date | 2012-02-25 |
| Last Update Date | 2013-06-19 |