| NPI | 1962993865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IN 35000876A) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2018-05-25 |
| Last Update Date | 2018-07-12 |