| NPI | 1437591641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 59578) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM C-09458) |
| Enumeration Date | 2013-07-29 |
| Last Update Date | 2022-07-21 |