| NPI | 1013781533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 104194) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: LA 18088) |
| Enumeration Date | 2023-11-15 |
| Last Update Date | 2024-11-25 |