| NPI | 1134426059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 7894027-6004) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: UT 7894027-6009) |
| Enumeration Date | 2011-02-14 |
| Last Update Date | 2023-04-26 |