| NPI | 1326542788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 62928) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM C-11411) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2023-03-20 |