| NPI | 1285075390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 7923306-3501) |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 7923306-3502) |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2016-06-16 |