| NPI | 1639146715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: TX 03359) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 03359) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2007-07-08 |