| NPI | 1649265075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 110802) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 32412) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2023-01-06 |