| NPI | 1942788765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: UT 12256128-3501) |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 12256128-3501) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-08-02 |
| Last Update Date | 2023-04-26 |