| NPI | 1265815062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 62896) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 62896) |
| 101Y00000X Counselor (Licence: CT 001831) | |
| 104100000X Social Worker (Licence: CT 001831) | |
| 104100000X Social Worker (Licence: TX 62896) | |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2023-07-28 |