| NPI | 1568447100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: IN 34000010A) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IN 34000010A) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2009-04-29 |