| NPI | 1114394327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 9424653-3501) |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 9424853-3502) |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2019-10-08 |