| NPI | 1679337653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: TX 112627) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: FL SW22595) |
| Enumeration Date | 2024-02-09 |
| Last Update Date | 2024-05-29 |