| NPI | 1205810090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: IN 34002418A) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IN 34002418A) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2018-11-06 |