| NPI | 1457343386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM C-10739) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO 991828) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2019-11-08 |