| NPI | 1073583993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 64684) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-13438) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2020-02-03 |