| NPI | 1649377151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 4907) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 01016) |
| 106H00000X Marriage & Family Therapist (Licence: TX 01027) | |
| Enumeration Date | 2006-09-19 |
| Last Update Date | 2013-07-31 |