| NPI | 1679797633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 362589-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NV 5849-C) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2026-03-04 |