| NPI | 1710751540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 13260633-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID 4471287) |
| Enumeration Date | 2023-11-13 |
| Last Update Date | 2026-01-12 |