| NPI | 1235750399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AR P2306027) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 78630) |
| Enumeration Date | 2020-04-29 |
| Last Update Date | 2025-06-10 |