| NPI | 1285685149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: IN 34002910A) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IN 35000354A) |
| 101YM0800X Counselor Mental Health (Licence: IN 39000921A) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2007-07-26 |