| NPI | 1124678446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 57944) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 574944) |
| Enumeration Date | 2019-09-18 |
| Last Update Date | 2023-09-14 |