| NPI | 1013155548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: IN 34001870A) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IN 35001019A) |
| Enumeration Date | 2009-01-21 |
| Last Update Date | 2012-08-01 |