| NPI | 1780781013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: KS 2526) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: TX 55813) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2011-11-14 |