| 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 | 2025-10-01 |