| NPI | 1588792451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 55538) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-841) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2014-08-19 |