| NPI | 1467226530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 111246) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OK 22042) |
| Enumeration Date | 2023-11-09 |
| Last Update Date | 2025-10-28 |