| 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 |