| NPI | 1588677561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 9153) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 23403) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2007-07-08 |