| NPI | 1124326624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 77314983501) |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 77314983502) |
| Enumeration Date | 2011-03-07 |
| Last Update Date | 2019-06-10 |