| NPI | 1891864302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: IN 39000585A) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IN 34002613A) |
| 106H00000X Marriage & Family Therapist (Licence: IN 35000685A) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2007-07-08 |