| NPI | 1568767317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34006487A) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2011-01-25 |
| Last Update Date | 2012-09-20 |