| NPI | 1043647035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 346694-3501) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2013-10-04 |
| Last Update Date | 2025-07-21 |