| NPI | 1437259439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 42700) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 62368) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2011-05-17 |