| NPI | 1619523487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 11672517-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 11672517-3502) |
| Enumeration Date | 2019-08-16 |
| Last Update Date | 2024-05-20 |