| NPI | 1871845453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AR 8507-C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 118555) |
| Enumeration Date | 2012-10-08 |
| Last Update Date | 2026-04-11 |