| NPI | 1215318233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 14355) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 14355) |
| 101YM0800X Counselor, Mental Health (Licence: TX 14355) | |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2023-05-19 |