| NPI | 1265052278 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34010664A) | 
| Additional Taxonomies | 104100000X Social Worker (Licence: IN 33009813A) | 
| 101Y00000X Counselor | |
| Enumeration Date | 2020-04-20 | 
| Last Update Date | 2023-10-04 |