| NPI | 1063438786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: TX 16463) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 15917) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2025-09-11 |