| NPI | 1639493323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM M-08108) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 103202) |
| 1041C0700X Social Worker, Clinical (Licence: UT 10084958-3501) | |
| Enumeration Date | 2010-03-24 |
| Last Update Date | 2022-10-24 |