| NPI | 1487070694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: TX 54658) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 54658) |
| Enumeration Date | 2014-03-12 |
| Last Update Date | 2014-03-21 |