| NPI | 1285385500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 104360) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 104360) |
| Enumeration Date | 2022-01-18 |
| Last Update Date | 2023-12-12 |