| NPI | 1003863903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 12659) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 12659) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2008-03-13 |