| NPI | 1598439747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 000224685) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 107807) |
| Enumeration Date | 2021-08-02 |
| Last Update Date | 2025-03-26 |