| NPI | 1326579806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C013186) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 106956) |
| Enumeration Date | 2017-03-25 |
| Last Update Date | 2023-11-08 |