| NPI | 1114575131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IN 35002093A) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IN 39003521A) |
| Enumeration Date | 2019-09-03 |
| Last Update Date | 2020-12-01 |