| NPI | 1306578190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 89105) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 89105) |
| 101YM0800X Counselor, Mental Health (Licence: TX 89105) | |
| Enumeration Date | 2022-06-29 |
| Last Update Date | 2025-01-18 |