| NPI | 1164910089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 128158-3501) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: UT 128158-3501) |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2019-12-29 |