| NPI | 1730761529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 104516) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MD 22420) |
| Enumeration Date | 2021-04-22 |
| Last Update Date | 2024-09-05 |