| NPI | 1417507633 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 64948) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2024-12-16 |