| NPI | 1962619247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34007085A) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IN 33006386A) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2014-10-23 |