| NPI | 1124417340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 70767) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 70767) |
| Enumeration Date | 2015-01-12 |
| Last Update Date | 2024-07-09 |