| NPI | 1639738974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MS C9989) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: TX 66162) |
| 1041C0700X Social Worker Clinical (Licence: FL TPSW2507) | |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2024-01-23 |