| NPI | 1851799985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 8686227-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 8686227-3502) |
| Enumeration Date | 2014-12-05 |
| Last Update Date | 2016-06-20 |