| NPI | 1710451885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM M-10680) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NM X-10747) |
| Enumeration Date | 2019-01-11 |
| Last Update Date | 2019-09-13 |