| NPI | 1407212152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 70357) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 70357) |
| 101YP2500X Counselor, Professional (Licence: GA LPC014226) | |
| Enumeration Date | 2016-01-11 |
| Last Update Date | 2023-12-18 |