| NPI | 1245380732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 57403) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM I05793) |
| 1041C0700X Social Worker, Clinical (Licence: MT 959) | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2021-03-15 |