| NPI | 1104392042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 109774493-6004) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 10977493-6009) |
| Enumeration Date | 2018-10-18 |
| Last Update Date | 2024-12-09 |