| NPI | 1730260290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 58189) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2001027963) |
| 1041C0700X Social Worker, Clinical (Licence: KS 2204) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2022-06-13 |