| NPI | 1083654537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 02067) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NM I-07343) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2014-05-21 |