| NPI | 1831213826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 13692) |
| Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: TX 30906) |
| Enumeration Date | 2007-03-17 |
| Last Update Date | 2007-07-08 |