| NPI | 1497885776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 8539) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: TX 10995) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2007-07-08 |