| 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 |