| NPI | 1245228493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34000148A) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IN 35000083A) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2026-06-29 |