| NPI | 1922346725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 9169) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 57380) |
| Enumeration Date | 2013-01-29 |
| Last Update Date | 2024-05-20 |