| NPI | 1629100128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 34001688A) |
| Enumeration Date | 2007-03-10 |
| Last Update Date | 2025-02-26 |