| NPI | 1104810365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: TX 25952) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 25952) |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2012-07-24 |