| NPI | 1992882351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C000064) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 487) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2009-07-20 |