| NPI | 1336715259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 71008) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 108147) |
| Enumeration Date | 2021-06-01 |
| Last Update Date | 2024-09-25 |