| NPI | 1861529141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KY 104010) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IN 33006299A) |
| 106H00000X Marriage & Family Therapist (Licence: IN 35001769A) | |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2022-07-21 |