| NPI | 1023215142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34004012A) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL SW17800) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN 87000109A) | |
| 1041C0700X Social Worker, Clinical (Licence: IL 149025042) | |
| 1041C0700X Social Worker, Clinical (Licence: FL SW17800) | |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2025-08-04 |