| NPI | 1548348063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM C-05176) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCS23135) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2019-03-04 |