| NPI | 1225165566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NM I-3577) |
| Additional Taxonomies | 1041S0200X Social Worker School (Licence: NM I3577) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2015-02-02 |