| NPI | 1568663748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: IN 33002132A) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IN 35001197A) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2007-07-08 |