| NPI | 1386156495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 06371) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 113061) |
| Enumeration Date | 2017-10-30 |
| Last Update Date | 2026-08-04 |