| NPI | 1952682775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM LISWX193) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2011-09-07 |
| Last Update Date | 2012-01-12 |