| NPI | 1447238456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 5034190-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 5034190-3502) |
| 1041S0200X Social Worker, School (Licence: UT 5034190-3502) | |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2023-04-24 |