| NPI | 1285187419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.2102591) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 94100) |
| Enumeration Date | 2016-07-23 |
| Last Update Date | 2024-08-27 |