| NPI | 1073288775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: TX 69220) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: TX 69220) |
| Enumeration Date | 2021-08-13 |
| Last Update Date | 2021-09-14 |