| NPI | 1750485850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: IN 33001554A) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KY 2009-100) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2011-02-01 |