| NPI | 1649380502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NM I2267) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: TX 05339) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2007-07-08 |