| NPI | 1073198164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN 6451) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 107405) |
| Enumeration Date | 2021-03-10 |
| Last Update Date | 2026-07-15 |