| NPI | 1770787459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 348145-3501) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 3481453501) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2020-01-03 |