| NPI | 1184065773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YS0200X Counselor School (Licence: TX 33866) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 33866) |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: TX 33866) | |
| Enumeration Date | 2013-07-11 |
| Last Update Date | 2013-07-11 |