| NPI | 1124036405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IN 39001368A) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IN 35000317A) |
| 1041C0700X Social Worker, Clinical (Licence: IN 35000317A) | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2008-02-07 |