NPI | 1114130119 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX S25118) |
Additional Taxonomies | 101Y00000X Counselor (Licence: TX S25118) |
103T00000X Psychologist (Licence: TX S25118) | |
104100000X Social Worker (Licence: TX S25118) | |
Enumeration Date | 2007-05-07 |
Last Update Date | 2009-09-16 |