| NPI | 1487786935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34000534A) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IN 35000242A) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN 87000437A) | |
| Enumeration Date | 2007-03-11 |
| Last Update Date | 2013-08-19 |