| NPI | 1477856524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 13606) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 460) |
| Enumeration Date | 2010-12-13 |
| Last Update Date | 2011-09-01 |