| NPI | 1700079514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 63214) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: TX 63214) |
| 101Y00000X Counselor (Licence: TX 63214) | |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2010-07-19 |