| NPI | 1558796128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 10516521-3501) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: CA 76799) | |
| Enumeration Date | 2013-09-13 |
| Last Update Date | 2022-05-16 |