| NPI | 1568476307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: TX 50862) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: TN 4699) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2008-07-23 |