| NPI | 1679746846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: UT 138978-3501) |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 138978 3501) |
| Enumeration Date | 2008-04-09 |
| Last Update Date | 2020-03-31 |