| NPI | 1992568034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 121694) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 104100000X Social Worker (Licence: TX 109616) | |
| Enumeration Date | 2024-02-01 |
| Last Update Date | 2024-09-19 |