| NPI | 1144566951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 69923) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM 0153611) |
| Enumeration Date | 2012-12-26 |
| Last Update Date | 2018-03-27 |