| NPI | 1366862914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 10611479-6004) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 10611479-6009) |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2020-10-16 |