| NPI | 1487263786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NM M-11502) |
| Additional Taxonomies | 101Y00000X Counselor |
| 1041C0700X Social Worker, Clinical (Licence: NM M-11502) | |
| Enumeration Date | 2020-07-23 |
| Last Update Date | 2020-12-18 |