| NPI | 1528144847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 51513643501) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: UT 51513643502) |
| Enumeration Date | 2006-10-30 |
| Last Update Date | 2024-08-20 |