| NPI | 1063301208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: TN 0000012857) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TN 0000012857) |
| Enumeration Date | 2025-07-01 |
| Last Update Date | 2025-07-01 |