| NPI | 1013343938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OK 5934) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 91590) |
| Enumeration Date | 2013-09-24 |
| Last Update Date | 2026-04-10 |