| NPI | 1639104219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 65197) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY 1935) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2026-04-25 |