| NPI | 1497781496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NM C-09948) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MA 110336) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2018-10-12 |