| NPI | 1659674570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM C-08311) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NM M-07509) |
| Enumeration Date | 2010-12-15 |
| Last Update Date | 2017-05-04 |