| NPI | 1902006216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 14189967-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL sw 4677) |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2024-11-12 |