| NPI | 1174877526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: TN 3278) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MS 1661) |
| 101YM0800X Counselor Mental Health (Licence: TX 62605) | |
| Enumeration Date | 2012-11-07 |
| Last Update Date | 2016-07-15 |