| NPI | 1265569073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: TX 08693) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 3876) |
| 1041C0700X Social Worker, Clinical (Licence: TX 08693) | |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2016-06-10 |