| NPI | 1851882054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: TX 115131) |
| Additional Taxonomies | 104100000X Social Worker (Licence: LA 13945) |
| 1041C0700X Social Worker Clinical (Licence: LA 13945) | |
| 171M00000X Case Manager/Care Coordinator (Licence: LA 13945) | |
| Enumeration Date | 2018-05-23 |
| Last Update Date | 2025-03-26 |