| NPI | 1063647303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NV 8194-c) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 224Z00000X Occupational Therapy Assistant (Licence: TX 210433) | |
| Enumeration Date | 2009-05-15 |
| Last Update Date | 2024-07-11 |