| NPI | 1184383283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX 82314) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: 82314) |
| Enumeration Date | 2021-12-16 |
| Last Update Date | 2023-11-14 |