| NPI | 1730647264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: UT 13348862-3503) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 13348862-3502) |
| 171M00000X Case Manager/Care Coordinator | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-04 |
| Last Update Date | 2025-06-09 |