| NPI | 1912139353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 65074) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 65074) |
| 101YM0800X Counselor, Mental Health (Licence: TX 65074) | |
| Enumeration Date | 2009-08-19 |
| Last Update Date | 2013-05-28 |