| NPI | 1154545093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-37720) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 41939) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2022-05-05 |