| NPI | 1003396375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 65248) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 65248) |
| Enumeration Date | 2018-08-16 |
| Last Update Date | 2024-03-27 |