| NPI | 1619353885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 7667381-3502) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 104100000X Social Worker (Licence: UT 76673813503) | |
| Enumeration Date | 2015-08-10 |
| Last Update Date | 2021-05-26 |