| NPI | 1962728964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 5712144-3501) |
| Additional Taxonomies | 253J00000X Foster Care Agency (Licence: UT 5712144-3501) |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2016-10-25 |