| NPI | 1588275663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 61030) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW61326796) |
| Enumeration Date | 2020-08-12 |
| Last Update Date | 2022-09-19 |