| NPI | 1265077523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 11508157-6004) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WY LPC2523) |
| Enumeration Date | 2019-11-11 |
| Last Update Date | 2026-06-08 |