| NPI | 1366624298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 10473) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 01315) |
| Enumeration Date | 2007-12-03 |
| Last Update Date | 2007-12-03 |