| NPI | 1528194628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34002260A) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IN 35000152A) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2008-10-02 |