| NPI | 1659584977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM I-07492) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 5789992-3501) |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2026-05-26 |