| NPI | 1427394113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 61216) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OK 5050) |
| Enumeration Date | 2012-12-27 |
| Last Update Date | 2019-02-19 |