| NPI | 1558827949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 103941) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY 253892) |
| Enumeration Date | 2019-02-11 |
| Last Update Date | 2023-08-25 |