| NPI | 1598154023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34003155A) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904005644) |
| Enumeration Date | 2015-01-21 |
| Last Update Date | 2018-04-12 |