| NPI | 1255705984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IN 35001320A) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN 87001228A) |
| 1041C0700X Social Worker, Clinical (Licence: IN 34003077A) | |
| Enumeration Date | 2015-11-18 |
| Last Update Date | 2015-11-20 |