| NPI | 1457654873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: UT 5705314-6004) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: UT 5705314-6004) |
| Enumeration Date | 2010-12-07 |
| Last Update Date | 2023-04-27 |