| NPI | 1619017019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 17903) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: TX 17903) |
| 101YS0200X Counselor School (Licence: TX CERTIFICATE) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2008-09-09 |