| NPI | 1477246551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 113123) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OK 20307-P) |
| Enumeration Date | 2023-06-02 |
| Last Update Date | 2026-08-24 |