| NPI | 1285685073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TN LPC0000001646) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 91585) |
| 101YM0800X Counselor Mental Health (Licence: TX 91585) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2023-05-06 |