| NPI | 1467928978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 71982) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 4226780-6004) |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2025-10-28 |