| NPI | 1497211825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 253837) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM SWB-2023-0351) |
| Enumeration Date | 2019-02-11 |
| Last Update Date | 2024-05-03 |