| NPI | 1407235369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: UT 10196373-3502) |
| Additional Taxonomies | 1041S0200X Social Worker School |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2017-02-06 |