| NPI | 1780131029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 121745) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 104756) |
| Enumeration Date | 2016-09-02 |
| Last Update Date | 2026-07-28 |