| NPI | 1295957025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 377756-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OK 3133) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2010-02-23 |