| NPI | 1306018551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX LCSW 50747) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 50747) |
| Enumeration Date | 2008-03-27 |
| Last Update Date | 2008-03-27 |