| NPI | 1508910092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 322256-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO 992679) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2014-01-13 |