| NPI | 1639966781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 4131) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 114946) |
| Enumeration Date | 2025-04-22 |
| Last Update Date | 2025-04-22 |