| NPI | 1225332695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: IN 34002434A) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: IN 87000453A) |
| 101YM0800X Counselor Mental Health (Licence: IN 39000673A) | |
| 106H00000X Marriage & Family Therapist (Licence: IN 35000720A) | |
| Enumeration Date | 2010-12-29 |
| Last Update Date | 2012-03-20 |