| NPI | 1992879910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: UT 115015-2501) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: UT 115015-2501) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2007-07-08 |