| NPI | 1386649622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34002273A) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IN 35000058A) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2010-01-07 |