| NPI | 1437498565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 10126079-3501) |
| Enumeration Date | 2013-02-08 |
| Last Update Date | 2025-11-20 |