| NPI | 1184409260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 105904) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW24297) |
| Enumeration Date | 2023-08-28 |
| Last Update Date | 2025-04-11 |