| NPI | 1831880251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 13382587-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 110324) |
| Enumeration Date | 2023-05-17 |
| Last Update Date | 2025-11-18 |