| NPI | 1194125625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 9455497-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 9455497-3502) |
| Enumeration Date | 2014-09-03 |
| Last Update Date | 2023-09-21 |