| NPI | 1053498055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 16828) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 3298) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2010-09-21 |