| NPI | 1710218086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: IN 39000529A) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: IN 34003076A) |
| Enumeration Date | 2010-01-26 |
| Last Update Date | 2010-01-26 |