| NPI | 1760731566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM M-07604) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: NM M-07604) |
| Enumeration Date | 2012-09-07 |
| Last Update Date | 2012-09-07 |