| NPI | 1659420503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 5841066-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-25605) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2007-07-08 |