NPI | 1962598482 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX LPC11789) |
Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: TX LPC11789) |
Enumeration Date | 2006-10-04 |
Last Update Date | 2007-07-08 |