| NPI | 1528531761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 7249138-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 7249138-3502) |
| Enumeration Date | 2019-01-10 |
| Last Update Date | 2022-10-11 |