| NPI | 1184857252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM M-07852) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM X-07410) |
| Enumeration Date | 2009-08-24 |
| Last Update Date | 2012-01-11 |