| NPI | 1417395104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 79894) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: TX 105977) |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2023-03-06 |