| NPI | 1780672915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: UT 134722-3501) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: UT 134722-3501) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2012-11-05 |