| NPI | 1437426186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM X09627) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical (Licence: NM M-08018) | |
| Enumeration Date | 2011-11-23 |
| Last Update Date | 2022-08-05 |