| NPI | 1497947592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: TX 55033) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: LA 14631) |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2025-07-29 |