| NPI | 1487754263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NM I-07022) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CO 989555) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2013-04-09 |