| NPI | 1689746554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM C-10278) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM M-04628) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2020-06-10 |