| NPI | 1487261848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: UT 291140-6004) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 291140-6004) |
| Enumeration Date | 2020-09-29 |
| Last Update Date | 2020-10-05 |