| NPI | 1235414350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: UT 7903342-6004) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: UT 7903342-6009) |
| Enumeration Date | 2011-10-20 |
| Last Update Date | 2020-06-10 |