| NPI | 1326160268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: IN 34002600A) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IN 39000618A) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2012-07-13 |