| NPI | 1922882836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AK 212153) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 66556) |
| Enumeration Date | 2023-08-22 |
| Last Update Date | 2023-08-22 |