| NPI | 1326912569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 100551) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: MS 468) |
| 101YP2500X Counselor, Professional (Licence: MS 3329) | |
| Enumeration Date | 2025-10-01 |
| Last Update Date | 2026-01-13 |