| NPI | 1801336656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 62553) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 62553) |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2021-01-18 |