| NPI | 1801058508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IN 35000500A) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 39000746A) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2008-06-25 |