| NPI | 1053918334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 79786) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 79786) |
| Enumeration Date | 2020-10-08 |
| Last Update Date | 2021-07-23 |