| NPI | 1245836121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 78229) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 78229) |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2020-12-07 |
| Last Update Date | 2020-12-07 |