| NPI | 1831162486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IN 39001550A) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IN 39001550A) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2011-06-01 |