| NPI | 1649335266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 10457) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: VA 0810003643) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2007-07-08 |