| NPI | 1508514050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C014231) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 111203) |
| Enumeration Date | 2022-03-14 |
| Last Update Date | 2026-03-19 |