| NPI | 1760588818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 5974695-3501) |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 59746953502) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2019-06-18 |