| NPI | 1306928080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 286356-3501) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2023-08-22 |