| NPI | 1639192966 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IN 35001433) | 
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 39000224) | 
| Enumeration Date | 2006-07-26 | 
| Last Update Date | 2025-09-11 |