| NPI | 1114357985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IA 085938) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 51472) |
| Enumeration Date | 2013-11-15 |
| Last Update Date | 2019-11-21 |