| NPI | 1225347503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 16845) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY 257901) |
| Enumeration Date | 2010-10-04 |
| Last Update Date | 2023-12-04 |