| NPI | 1548677818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM C-10540) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NM X-10416) |
| Enumeration Date | 2014-07-17 |
| Last Update Date | 2025-08-28 |