| NPI | 1316408867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: TX 03924) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2019-03-27 |