| NPI | 1174746960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX LPC 60506) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX LPC 60506) |
| 101YP1600X Counselor, Pastoral (Licence: TX LPC 60506) | |
| 101YS0200X Counselor, School (Licence: TX Educator Cert.) | |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2007-07-08 |