| NPI | 1639138506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34001216A) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 34001216A) |
| 101Y00000X Counselor (Licence: IN 34001216A) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN 34001216A) | |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2016-05-25 |