| NPI | 1720328446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34005677A) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN 87001442A) |
| 1041S0200X Social Worker, School (Licence: IN 1619240) | |
| Enumeration Date | 2013-02-15 |
| Last Update Date | 2013-02-15 |