| NPI | 1932308962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX LCSW15499) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX LPC 10983) |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2010-04-23 |