NPI | 1669160057 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 59735) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 1123431) |
Enumeration Date | 2023-04-25 |
Last Update Date | 2023-07-14 |