| NPI | 1598421604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041S0200X Social Worker, School (Licence: NM 367786) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM x-12152) |
| Enumeration Date | 2021-11-12 |
| Last Update Date | 2021-11-12 |