| NPI | 1023475670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 10147961-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: LA 11817) |
| Enumeration Date | 2016-01-26 |
| Last Update Date | 2024-01-08 |