| NPI | 1134322209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX S14689) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 9401) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2016-09-30 |