| NPI | 1356347231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AR C-1098) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 27104) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2007-07-08 |