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 |