| NPI | 1972778199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 17012) |
| Additional Taxonomies | 103TS0200X Psychologist School (Licence: TX 32607) |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2008-04-29 |