| NPI | 1437768074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 13164210-6004) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 97321) |
| Enumeration Date | 2020-07-29 |
| Last Update Date | 2026-04-22 |