| NPI | 1154871978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 66610) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: LA 12867) |
| Enumeration Date | 2016-10-05 |
| Last Update Date | 2022-04-26 |