| NPI | 1104263375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM C-09361) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NM X-08198) |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2018-12-01 |