| NPI | 1265921209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 10768634-6009) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: UT 92449) |
| Enumeration Date | 2018-05-04 |
| Last Update Date | 2018-05-04 |