| NPI | 1477782506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 77590) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LC2797) |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2018-10-02 |