| NPI | 1770568321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34003025A) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IN 35001314) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2014-05-22 |