| NPI | 1447621727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 56734) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW61280252) |
| Enumeration Date | 2015-10-13 |
| Last Update Date | 2023-02-22 |