| NPI | 1487783239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 62101) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 1774) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2026-05-19 |