| NPI | 1154340768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C005319) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 65730) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2023-09-30 |