| NPI | 1659643724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 42432) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM I-06946) |
| Enumeration Date | 2012-02-03 |
| Last Update Date | 2012-02-03 |