| NPI | 1760586945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX S10635) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 2511) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2010-08-25 |