| NPI | 1790355477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM C-11784) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ND 26642) |
| Enumeration Date | 2021-06-25 |
| Last Update Date | 2021-06-25 |