| NPI | 1821848383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 13668433-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID 2871657) |
| 1041C0700X Social Worker, Clinical (Licence: FL TPSW5503) | |
| 1041C0700X Social Worker, Clinical (Licence: SC TLS1326CP) | |
| Enumeration Date | 2024-03-26 |
| Last Update Date | 2026-06-11 |