| NPI | 1316296262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 80764) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 004166) |
| Enumeration Date | 2012-09-06 |
| Last Update Date | 2023-10-24 |