NPI | 1184882722 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 289868-3501) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 289868-3502) |
Enumeration Date | 2008-05-30 |
Last Update Date | 2020-03-17 |