| NPI | 1174200018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 107915) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09932236) |
| Enumeration Date | 2023-07-03 |
| Last Update Date | 2025-08-30 |