| NPI | 1760467328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: IN 34002314A) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IN 35000015A) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2018-02-28 |