| NPI | 1043788722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 70366) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 70366) |
| Enumeration Date | 2018-11-11 |
| Last Update Date | 2026-07-07 |