| NPI | 1255140356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR R10808) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 97035) |
| Enumeration Date | 2025-01-03 |
| Last Update Date | 2025-02-28 |