| NPI | 1013657998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN 7098) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ 22500) |
| 1041C0700X Social Worker, Clinical (Licence: LA 16945) | |
| 1041C0700X Social Worker, Clinical (Licence: TX 113090) | |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2025-07-23 |