| NPI | 1184284051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C014188) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 67963) |
| Enumeration Date | 2019-06-13 |
| Last Update Date | 2025-01-16 |