| NPI | 1265617484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX LPC 01604) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX LPA-4347) |
| 101YP2500X Counselor, Professional (Licence: TX APA Diplomate 4720) | |
| Enumeration Date | 2008-01-07 |
| Last Update Date | 2008-01-07 |