| NPI | 1003179508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IN 85000180A) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2023-01-25 |