| NPI | 1790146595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IN 39001063A) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN 39001063A) |
| 104100000X Social Worker (Licence: IN 33002117A) | |
| Enumeration Date | 2016-03-08 |
| Last Update Date | 2016-03-08 |