| NPI | 1992826218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 3298-123) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WI 143-124) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2008-12-15 |