| NPI | 1811614902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: UT 11860143-3502) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: UT 11860143-3503) |
| Enumeration Date | 2022-10-20 |
| Last Update Date | 2024-08-28 |