| NPI | 1376740886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 104100000X Social Worker (Licence: IN 33002247A) |
| 106H00000X Marriage & Family Therapist (Licence: IN 35000657A) | |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2007-07-09 |