| NPI | 1881651776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 77721) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 77721) |
| 104100000X Social Worker (Licence: MI 6801066144) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2022-06-14 |