NPI | 1720234552 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX LPC#8689) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 8689) |
Enumeration Date | 2008-08-12 |
Last Update Date | 2012-04-10 |