| NPI | 1396765103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX S00702) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 001704) |
| 101YP2500X Counselor, Professional (Licence: TX 000861) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2007-07-09 |