| NPI | 1770193559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 7951342-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MS C9640) |
| Enumeration Date | 2020-08-05 |
| Last Update Date | 2021-11-30 |