| NPI | 1275920480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 79781) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 6174-125) |
| Enumeration Date | 2015-04-25 |
| Last Update Date | 2019-06-04 |