| NPI | 1568292050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: TX 108030) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 108030) |
| Enumeration Date | 2024-08-07 |
| Last Update Date | 2025-05-06 |