| NPI | 1669716924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 10834612-3501) |
| Additional Taxonomies | 101Y00000X Counselor |
| 104100000X Social Worker (Licence: UT 10834612-3501) | |
| 253J00000X Foster Care Agency | |
| Enumeration Date | 2012-11-26 |
| Last Update Date | 2022-11-22 |