| NPI | 1609502160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: TX 106826) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 106826) |
| Enumeration Date | 2022-07-27 |
| Last Update Date | 2026-06-29 |