| NPI | 1992835680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 1005923501) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 1005923902) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2020-01-27 |