| NPI | 1750869863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 10834446-3501) |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 10834446-3502) |
| Enumeration Date | 2018-07-31 |
| Last Update Date | 2022-08-18 |