| NPI | 1194199208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 96952) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 7635) |
| 101YM0800X Counselor, Mental Health (Licence: TX 96952) | |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2025-10-03 |