| NPI | 1104545383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 13396982-3501) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2022-08-23 |
| Last Update Date | 2025-04-30 |