| NPI | 1881620961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX 15797) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 32628) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2007-07-08 |