| NPI | 1184971210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 65423) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW10936) |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2020-08-19 |