| NPI | 1407458730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 88725) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 88725) |
| 224Z00000X Occupational Therapy Assistant (Licence: TX 208648) | |
| Enumeration Date | 2020-11-11 |
| Last Update Date | 2022-07-22 |