| NPI | 1922622174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 79519) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 107452) |
| 1041C0700X Social Worker, Clinical (Licence: TN 6771) | |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2024-01-15 |