| NPI | 1861026544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NM C-10953) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: FL FLSW16898) |
| Enumeration Date | 2020-03-02 |
| Last Update Date | 2024-12-19 |