| NPI | 1578296604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 12808152-3501) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2022-07-06 |
| Last Update Date | 2024-10-23 |