| NPI | 1528316981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 57216) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: LA 10408) |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2014-11-14 |