| NPI | 1033549944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 12442) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 67549) |
| Enumeration Date | 2013-11-14 |
| Last Update Date | 2022-06-01 |