| 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 |