| NPI | 1861196370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 93585) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: TX 56818) |
| Enumeration Date | 2023-03-28 |
| Last Update Date | 2023-03-30 |