| NPI | 1568981066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 53008) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ 22312) |
| Enumeration Date | 2017-09-15 |
| Last Update Date | 2025-01-29 |