| NPI | 1134866858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 86807) |
| Enumeration Date | 2022-05-14 |
| Last Update Date | 2023-11-01 |