| NPI | 1821529371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 108047) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IN 33008102A) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2023-02-15 |