| NPI | 1255651824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: UT 68222416004) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: UT 6822241-6004) |
| Enumeration Date | 2010-06-07 |
| Last Update Date | 2013-09-13 |