| NPI | 1306927769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IN 39000420A) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IN 34002741A) |
| 106H00000X Marriage & Family Therapist (Licence: IN 35000135A) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2013-12-23 |