| NPI | 1932256096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IN 39000734A) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IN 35001337A) |
| 106H00000X Marriage & Family Therapist (Licence: KY 0138) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2014-09-03 |