| NPI | 1568535441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 14862) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 10249) |
| 106H00000X Marriage & Family Therapist (Licence: TX 2288) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2007-10-10 |