| NPI | 1225528284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 75700) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: TX 75700) |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2023-08-18 |