| NPI | 1023133485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM I-07195) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 1024428) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2020-06-02 |