| NPI | 1245228493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: IN 34000148A) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IN 34000148A) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2018-04-23 |