| NPI | 1225199524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: TX 25667) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 25667) |
| 171M00000X Case Manager/Care Coordinator (Licence: TX 220041512) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2017-01-26 |