| NPI | 1568628667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM C-10047) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM M-08603) |
| Enumeration Date | 2008-07-29 |
| Last Update Date | 2018-09-07 |