| NPI | 1669364774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 110546) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IA 133840) |
| Enumeration Date | 2025-07-15 |
| Last Update Date | 2025-10-14 |