| NPI | 1497263958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 98425) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 3877) |
| 101YP2500X Counselor, Professional (Licence: NE 3877) | |
| Enumeration Date | 2018-01-18 |
| Last Update Date | 2025-07-16 |