| NPI | 1285744417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 10524) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 10524) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2026-03-04 |