| NPI | 1235241449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 59308833502) |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 59308833502) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2023-04-27 |