| NPI | 1669508289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 52863) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCS 13246) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2013-08-22 |