| NPI | 1679860951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 60137) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 60137) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2025-04-29 |