| NPI | 1114236130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AR P1607094) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 76568) |
| 101YP2500X Counselor, Professional (Licence: KS LCPC2791) | |
| 101YP2500X Counselor, Professional (Licence: GA LPC012268) | |
| Enumeration Date | 2010-09-27 |
| Last Update Date | 2025-10-09 |