| NPI | 1063766194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 62819) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 102422) |
| Enumeration Date | 2012-10-26 |
| Last Update Date | 2022-12-07 |