| NPI | 1811472962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041S0200X Social Worker, School (Licence: NM x-10610) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: UT 1811472962) |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2018-09-25 |
| Last Update Date | 2022-03-22 |