| NPI | 1023503844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: TX 67658) | |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2023-11-28 |