| NPI | 1306998232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 62540) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 62540) |
| 101Y00000X Counselor (Licence: TX 62540) | |
| 103K00000X Behavior Analyst (Licence: TX 62540) | |
| 102L00000X Psychoanalyst (Licence: TX 62540) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2011-12-20 |