| NPI | 1326239864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM C-07174) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM M06343) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2024-03-11 |