| NPI | 1659967123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 5544220-3501) |
| Additional Taxonomies | 1041S0200X Social Worker, School |
| 1041C0700X Social Worker, Clinical (Licence: UT 5544220-3502) | |
| 104100000X Social Worker (Licence: UT 5544220-3501) | |
| Enumeration Date | 2020-12-17 |
| Last Update Date | 2024-03-01 |