| NPI | 1295785210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 41557) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 41557) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2014-12-04 |