| NPI | 1013433051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM C-10912) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NM M-10034) |
| 1041C0700X Social Worker, Clinical (Licence: NM X-11107) | |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2019-09-11 |