| NPI | 1447089594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 116968) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY 256402) |
| Enumeration Date | 2024-07-29 |
| Last Update Date | 2026-06-30 |