| NPI | 1922075209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: IN 34002601A) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IN 39000428A) |
| 106H00000X Marriage & Family Therapist (Licence: IN 35000705A) | |
| 101Y00000X Counselor (Licence: IN 34002601A) | |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: IN 34002601A) | |
| Enumeration Date | 2006-03-04 |
| Last Update Date | 2009-04-29 |