| NPI | 1932281839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C009462) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: TX 188448) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2025-04-24 |