| NPI | 1063070647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: UT 12905660-6004) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: ID LCPC-9052) |
| Enumeration Date | 2019-05-30 |
| Last Update Date | 2024-03-22 |