| NPI | 1003034240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 266439-3501) |
| Additional Taxonomies | 251S00000X (Licence: UT 266439-3501) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2007-07-08 |