| NPI | 1568830024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 61347) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 61347) |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2019-11-18 |