| NPI | 1922657113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 68193) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 68193) |
| Enumeration Date | 2019-09-10 |
| Last Update Date | 2023-08-11 |