| NPI | 1457526337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: UT 2785863-6004) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: UT 2785863-6004) |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2009-11-11 |