| NPI | 1134888019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 65175) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C017412) |
| Enumeration Date | 2021-12-08 |
| Last Update Date | 2025-06-06 |