| NPI | 1740916014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 109000) |
| Additional Taxonomies | 104100000X Social Worker |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-07-28 |
| Last Update Date | 2023-03-23 |