| NPI | 1285858910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 13163) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 14606) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2008-08-15 |