| NPI | 1831591486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 57038) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2014-09-25 |
| Last Update Date | 2025-01-02 |