| NPI | 1194267997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 11692670-6004) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 11692670-6009) |
| 101YP2500X Counselor, Professional (Licence: UT 11692670-6009) | |
| Enumeration Date | 2016-11-09 |
| Last Update Date | 2025-04-27 |