| NPI | 1306179841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 56109) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 62495) |
| Enumeration Date | 2009-09-16 |
| Last Update Date | 2016-01-04 |