| NPI | 1831417633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 59660) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ 21506) |
| 1041C0700X Social Worker, Clinical (Licence: OK 20486) | |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2023-09-18 |