| NPI | 1891787842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX 10384) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 20423) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2007-07-09 |