| NPI | 1053978619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 100849) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 19999) |
| Enumeration Date | 2019-05-20 |
| Last Update Date | 2026-04-02 |