| NPI | 1710211081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 3293) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: 5870) |
| 106H00000X Marriage & Family Therapist (Licence: TX 1983) | |
| Enumeration Date | 2009-09-19 |
| Last Update Date | 2009-09-19 |