| NPI | 1053620732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 423) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 64697) |
| Enumeration Date | 2010-09-29 |
| Last Update Date | 2015-12-17 |