| NPI | 1740456805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 17033) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 17033) |
| 103K00000X Behavior Analyst (Licence: TX 17033) | |
| 101Y00000X Counselor (Licence: TX 17033) | |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2011-01-19 |