| NPI | 1720564917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 62252) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904018643) |
| Enumeration Date | 2018-07-11 |
| Last Update Date | 2026-03-16 |