| NPI | 1700996402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DE Q1-001977) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: TX 39126) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2021-11-24 |