| NPI | 1609000835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX 63851) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 63851) |
| Enumeration Date | 2009-05-01 |
| Last Update Date | 2009-05-01 |