| NPI | 1326061854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 197117-3501) |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 197117-3503) |
| 164W00000X Licensed Practical Nurse (Licence: UT 197117-3101) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2013-10-24 |