| NPI | 1740264621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34002610A) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 39000626A) |
| Enumeration Date | 2005-12-03 |
| Last Update Date | 2018-03-22 |