| NPI | 1265696751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: UT 111470-6004) |
| Additional Taxonomies | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: MO 26-0605001) |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2024-09-20 |