| NPI | 1174531628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM C-06202) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM I-06202) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2018-06-18 |