| NPI | 1154927044 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 81698) | 
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR C8741) | 
| 101YP2500X Counselor, Professional (Licence: TX 81698) | |
| Enumeration Date | 2020-12-07 | 
| Last Update Date | 2025-10-13 |