| NPI | 1295123693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: IN 34005929A) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: IN 87000014A) |
| Enumeration Date | 2015-01-07 |
| Last Update Date | 2025-08-26 |