| NPI | 1740422294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX 67059) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 39190) |
| Enumeration Date | 2009-03-30 |
| Last Update Date | 2014-09-12 |