| NPI | 1306438114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 81158) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 81158) |
| Enumeration Date | 2021-02-04 |
| Last Update Date | 2024-05-29 |