| NPI | 1053888602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 62381) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 62381) |
| Enumeration Date | 2018-10-31 |
| Last Update Date | 2024-01-31 |