| NPI | 1962770487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C007553) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 58204) |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2015-10-09 |