| NPI | 1881638815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34001642A) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 39001098A) |
| 106H00000X Marriage & Family Therapist (Licence: IN 35000874A) | |
| 163W00000X Registered Nurse (Licence: IN 28169390A) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2016-04-05 |