| NPI | 1205233830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX LPC.91630) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM CMH0203311) |
| Enumeration Date | 2014-11-25 |
| Last Update Date | 2026-03-11 |