| NPI | 1093595126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 93146) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 93146) |
| Enumeration Date | 2023-10-05 |
| Last Update Date | 2025-05-23 |