| NPI | 1063430155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IN 39000584A) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IN 34002563A) |
| 106H00000X Marriage & Family Therapist (Licence: IN 35000883A) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2007-07-08 |