| NPI | 1982017794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 69342) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-38395) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2020-08-26 |