| NPI | 1154659027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 74100103501) |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 74100103502) |
| Enumeration Date | 2009-12-03 |
| Last Update Date | 2012-07-27 |