| NPI | 1093745184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 101265-3501) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 101265-3902) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2007-07-08 |