| NPI | 1619908019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34000811) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IN 35000373) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2018-04-06 |