| NPI | 1124491279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 66034) |
| Additional Taxonomies | 101Y00000X Counselor |
| 1041C0700X Social Worker, Clinical | |
| 1041C0700X Social Worker, Clinical (Licence: LA 17160) | |
| Enumeration Date | 2015-11-10 |
| Last Update Date | 2022-06-14 |