| NPI | 1033312285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 5970944-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WY lcsw-712) |
| 1041C0700X Social Worker, Clinical (Licence: NV 8566-C) | |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2023-09-26 |