| NPI | 1306521612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 21531) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 92064) |
| Enumeration Date | 2023-06-15 |
| Last Update Date | 2026-06-11 |