| NPI | 1326499120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-9219) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT LCMHC-13656427-6004) |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2024-07-31 |