| NPI | 1003183914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 61409) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 32049) |
| Enumeration Date | 2011-11-20 |
| Last Update Date | 2011-11-20 |