| NPI | 1427325307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 60908) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM C-09031) |
| Enumeration Date | 2011-11-21 |
| Last Update Date | 2020-08-24 |