| NPI | 1265663884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM I-07430) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM M 06813) |
| Enumeration Date | 2009-07-30 |
| Last Update Date | 2012-12-13 |