| NPI | 1063496180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 09723) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM I-1142) |
| 106H00000X Marriage & Family Therapist (Licence: TX 265) | |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2011-10-21 |