| NPI | 1770624033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34005818A) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IN 33003035A) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2010-06-01 |