| NPI | 1306197603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 4758) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 113780) |
| Enumeration Date | 2012-09-26 |
| Last Update Date | 2025-09-17 |