| NPI | 1831133461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-41680) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 32270) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2022-09-08 |