| NPI | 1033125331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 14429) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2024-09-24 |