NPI | 1316963697 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101Y00000X Counselor (Licence: TX 10654LPC) |
Additional Taxonomies | 101Y00000X Counselor (Licence: TX 98LMFT) |
Enumeration Date | 2006-07-13 |
Last Update Date | 2007-07-08 |