| NPI | 1851734511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM C-095720) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-18567) |
| Enumeration Date | 2013-04-12 |
| Last Update Date | 2023-04-06 |