| NPI | 1942459995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 103853) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCSW25968) |
| Enumeration Date | 2008-09-15 |
| Last Update Date | 2024-08-19 |