| NPI | 1497939797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34000042A) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IN 35000036A) |
| Enumeration Date | 2007-12-21 |
| Last Update Date | 2007-12-21 |