| NPI | 1225513427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 11653409-3502) |
| 104100000X Social Worker (Licence: TX 66586) | |
| Enumeration Date | 2018-10-03 |
| Last Update Date | 2025-08-26 |