| NPI | 1972690303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: TX 14096) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 14096) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2008-08-26 |