| NPI | 1548245889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34002652A) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 34002652A) |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2014-04-30 |