| NPI | 1063686160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 284138-6004) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: UT 284138-6004) |
| Enumeration Date | 2008-04-18 |
| Last Update Date | 2021-10-04 |