| NPI | 1134937519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 26926) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 109682) |
| Enumeration Date | 2024-12-18 |
| Last Update Date | 2025-01-06 |