| NPI | 1164702445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 5601284-3501) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 104100000X Social Worker (Licence: UT 56012843502) | |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2015-06-17 |