| NPI | 1396996468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 7210) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 27280) |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2008-10-07 |