| NPI | 1790778124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: IN 34004597A) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: IN 87000150A) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2011-01-20 |