| NPI | 1265169460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 108350) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09932428) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2022-08-07 |
| Last Update Date | 2025-10-21 |