| NPI | 1225539638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 74286) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 101YM0800X Counselor, Mental Health (Licence: TX 74286) | |
| Enumeration Date | 2018-02-22 |
| Last Update Date | 2021-03-31 |