| NPI | 1619203056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 15217) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 0701) |
| Enumeration Date | 2009-10-20 |
| Last Update Date | 2009-10-20 |