| NPI | 1982214805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: TX 61870) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 103148) |
| Enumeration Date | 2020-08-05 |
| Last Update Date | 2021-10-16 |