| NPI | 1225513427 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 1041C0700X Social Worker, Clinical | 
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 66586) | 
| 104100000X Social Worker (Licence: UT 11653409-3502) | |
| 1041C0700X Social Worker, Clinical (Licence: CA 124478) | |
| Enumeration Date | 2018-10-03 | 
| Last Update Date | 2025-10-09 |