| NPI | 1285125286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 10834443-3501) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 10834443-3502) |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2020-09-09 |