| NPI | 1528132503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 114000-3501) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 114000-3902) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2010-09-13 |