| NPI | 1982856142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: AR M9802006) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: AR 109-C) |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2009-03-25 |