| NPI | 1346573128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX 62696) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CO LPC.0021362) |
| 101YM0800X Counselor, Mental Health (Licence: VT 068.0135481TELE) | |
| 101YP2500X Counselor, Professional (Licence: TX 62696) | |
| 103TC0700X Psychologist, Clinical (Licence: CA 35694) | |
| Enumeration Date | 2009-09-11 |
| Last Update Date | 2025-02-10 |