| NPI | 1922555093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 9826723-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 98267233501) |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2019-03-14 |