| NPI | 1477906824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 60655) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 60655) |
| 101YM0800X Counselor Mental Health (Licence: TX 60655) | |
| Enumeration Date | 2016-07-21 |
| Last Update Date | 2022-08-15 |