| NPI | 1306175377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 52967) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 10381) |
| Enumeration Date | 2009-12-21 |
| Last Update Date | 2014-03-20 |