| NPI | 1699221440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 71886) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 35680) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2017-04-18 |