| NPI | 1275560724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM I-05665) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TN LSW0000004849) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2021-04-05 |