| NPI | 1306076732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ SW 20331) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 01103) |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2018-03-14 |