| NPI | 1588854186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: TX 54202) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 214393) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2010-08-31 |