| NPI | 1801775044 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 104673) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 34066) |
| Enumeration Date | 2025-09-01 |
| Last Update Date | 2025-11-21 |