| NPI | 1205388642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NV IC-1745) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NV 8005-S) |
| Enumeration Date | 2016-11-02 |
| Last Update Date | 2021-08-05 |