| NPI | 1306500590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 12490452-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 24475) |
| Enumeration Date | 2021-10-25 |
| Last Update Date | 2021-10-25 |