| NPI | 1568993731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC P009725) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 60703) |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2017-03-21 |