| NPI | 1427490309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 67638) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 275800) |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2013-07-22 |