| NPI | 1114068608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 52691) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: NM I-06495) |
| 1041C0700X Social Worker, Clinical (Licence: IL 149-007725) | |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2026-08-26 |