| NPI | 1780053546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: IN 33008049A) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801098780) |
| Enumeration Date | 2015-09-22 |
| Last Update Date | 2018-02-06 |