| NPI | 1235674144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO .09925938) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 62586) |
| 1041C0700X Social Worker, Clinical (Licence: TX 62586) | |
| Enumeration Date | 2016-12-31 |
| Last Update Date | 2021-07-23 |