| NPI | 1174215800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 13241563-6009) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 13241563-6004) |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2024-09-18 |