| NPI | 1215164835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 55930) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IA 007307) |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2011-12-08 |