| NPI | 1144832114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: UT 10850038-3501) |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 10850038-3503) |
| Enumeration Date | 2020-08-20 |
| Last Update Date | 2025-05-19 |