| NPI | 1043009657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 14226136-6004) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LPC-23717) |
| Enumeration Date | 2025-05-01 |
| Last Update Date | 2025-12-11 |