| NPI | 1043019672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 54033) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: TX 54033) |
| Enumeration Date | 2025-03-07 |
| Last Update Date | 2025-04-11 |