| NPI | 1649977729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 13050151-3501) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2023-02-09 |
| Last Update Date | 2025-06-24 |