NPI | 1619795226 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 104209) |
Additional Taxonomies | 101Y00000X Counselor (Licence: TX 104209) |
Enumeration Date | 2024-10-01 |
Last Update Date | 2025-08-21 |