| NPI | 1619343746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM C-10779) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM M-08986) |
| Enumeration Date | 2015-08-12 |
| Last Update Date | 2023-08-28 |