| NPI | 1750791422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 8852826-3501) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 8852826-3501) |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2024-05-16 |