| NPI | 1124436035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 69897) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 5222) |
| Enumeration Date | 2014-07-24 |
| Last Update Date | 2019-09-13 |