| NPI | 1255579819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 10536765-6004) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC004990) |
| Enumeration Date | 2009-02-04 |
| Last Update Date | 2020-01-22 |