| NPI | 1356407589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 57341) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C005787) |
| Enumeration Date | 2006-12-30 |
| Last Update Date | 2023-02-27 |