| NPI | 1780058719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 52098) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 52098) |
| 1041S0200X Social Worker, School (Licence: TX 52098) | |
| Enumeration Date | 2015-11-13 |
| Last Update Date | 2015-11-13 |