| NPI | 1508126285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 77863566004) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 77863566009) |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2019-11-25 |