| NPI | 1558843466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 113918) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 093446) |
| Enumeration Date | 2018-09-06 |
| Last Update Date | 2025-08-15 |