| NPI | 1083929251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 102696253501) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-15629) | |
| Enumeration Date | 2010-08-12 |
| Last Update Date | 2024-11-25 |