| NPI | 1235493438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: HI MHC-491) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 66012) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2018-05-17 |