| NPI | 1356598569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 621369) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 62139) |
| Enumeration Date | 2008-08-20 |
| Last Update Date | 2025-06-23 |