| NPI | 1730330580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 41707) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 29037) |
| Enumeration Date | 2008-10-09 |
| Last Update Date | 2025-06-05 |