| NPI | 1619287679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 63867) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 63867) |
| 101YM0800X Counselor, Mental Health (Licence: TX 63867) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: TX 63867) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: TX 63867) | |
| Enumeration Date | 2010-10-08 |
| Last Update Date | 2012-03-30 |