| NPI | 1871236588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 106262) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TN 7726) |
| Enumeration Date | 2022-04-19 |
| Last Update Date | 2022-04-19 |