| NPI | 1972519452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 09716) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: TX 09814) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2007-07-08 |