| NPI | 1518026095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34002653A) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 39001336A) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2018-08-08 |