| NPI | 1639703259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: TX 61751) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA 115751) |
| Enumeration Date | 2020-02-24 |
| Last Update Date | 2023-08-14 |