| NPI | 1972871440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IN 20042705A) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IN 35001453A) |
| 106H00000X Marriage & Family Therapist (Licence: KY 0219) | |
| 106H00000X Marriage & Family Therapist (Licence: OH F . 1100008) | |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2013-11-18 |