| NPI | 1093701542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34000789A) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 39000848A) |
| 1041C0700X Social Worker, Clinical (Licence: IN 39000848A) | |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2022-02-03 |