| NPI | 1770757965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: IN 39000009A) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IN 33000999A) |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2008-04-17 |