| NPI | 1497444772 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 104100000X Social Worker (Licence: IN 33010895A) | 
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN 87900067A) | 
| Enumeration Date | 2023-05-03 | 
| Last Update Date | 2023-05-03 |