| NPI | 1588905715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 33002281A) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN 87001434A) |
| 101YM0800X Counselor, Mental Health (Licence: IN 39000242A) | |
| Enumeration Date | 2013-03-13 |
| Last Update Date | 2013-03-13 |