| NPI | 1285516575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 13416798-6004) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 13416798-6009) |
| Enumeration Date | 2025-07-25 |
| Last Update Date | 2025-08-06 |