| NPI | 1245653419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 62034) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW11708) |
| Enumeration Date | 2014-01-23 |
| Last Update Date | 2024-05-09 |