| NPI | 1689768152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 52305) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM I-06836) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2008-10-02 |