| NPI | 1043382542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: TX 62348) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: TX 37880) |
| 1041C0700X Social Worker Clinical (Licence: IL 149.008220) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2022-09-14 |