| NPI | 1982715736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 37938) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW 4190) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2010-09-15 |