| NPI | 1265748529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX 64712) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YM0800X Counselor Mental Health (Licence: TX 64712) | |
| 101YP2500X Counselor Professional (Licence: WI 10822125) | |
| 101YP2500X Counselor Professional (Licence: TX 64712) | |
| Enumeration Date | 2010-08-25 |
| Last Update Date | 2024-08-14 |