| NPI | 1801998406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX LCSWS14120) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NM LISWI2354) |
| 106H00000X Marriage & Family Therapist (Licence: TX LMFT50144348) | |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2012-05-02 |