| NPI | 1275159857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C015331) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 118244) |
| Enumeration Date | 2020-06-19 |
| Last Update Date | 2026-02-25 |