| NPI | 1144217290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX LCSW00357) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX LPC004887) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2008-07-24 |