| NPI | 1528434677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 9903821-3501) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: UT 9903821-3503) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-08-12 |
| Last Update Date | 2022-04-04 |