| NPI | 1265138564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 103782) |
| Enumeration Date | 2023-02-07 |
| Last Update Date | 2023-03-06 |