| NPI | 1790711539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IN 35000508A) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 39000464A) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2007-08-28 |