| NPI | 1982359014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 66134) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2022-02-17 |
| Last Update Date | 2022-05-17 |