| NPI | 1740317015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM I-06859) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: NM M05423) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2011-06-30 |