| NPI | 1346448669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OK 4047) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 59165) |
| Enumeration Date | 2007-07-08 |
| Last Update Date | 2023-10-30 |