| NPI | 1528481413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 6001178-3501) |
| Additional Taxonomies | 253J00000X Foster Care Agency (Licence: UT 21205) |
| Enumeration Date | 2014-01-28 |
| Last Update Date | 2019-09-25 |