| NPI | 1366772386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 66235) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: GA CSW004456) | |
| 1041C0700X Social Worker, Clinical (Licence: AR 7458-C) | |
| Enumeration Date | 2010-01-14 |
| Last Update Date | 2024-07-10 |