| NPI | 1144930868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 11318125) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 87416) |
| Enumeration Date | 2022-12-05 |
| Last Update Date | 2025-09-19 |