| NPI | 1740839406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 292932-3502) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2019-09-05 |
| Last Update Date | 2022-09-08 |