| NPI | 1235492877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 108488) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ SW-10092I) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2023-04-06 |