| NPI | 1184970956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 656626-3501) |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2016-06-09 |