| NPI | 1043510761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 52654) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 114706) |
| 1041C0700X Social Worker, Clinical (Licence: FL SW9526) | |
| 1041C0700X Social Worker, Clinical (Licence: GA CSW004296) | |
| Enumeration Date | 2010-10-27 |
| Last Update Date | 2010-10-27 |