| NPI | 1871974352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 104598) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NV 11722-C) |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2026-04-27 |