| NPI | 1083934558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 14894) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX S14894) |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2020-05-14 |