| NPI | 1619994555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 19460) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM I-3337) |
| 106H00000X Marriage & Family Therapist (Licence: TX 343) | |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2007-07-08 |