| NPI | 1437614237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 87217) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 87217) |
| 101YM0800X Counselor, Mental Health (Licence: TX 78217) | |
| Enumeration Date | 2019-02-05 |
| Last Update Date | 2024-08-27 |