| NPI | 1508181322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 63200) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 63200) |
| Enumeration Date | 2010-04-05 |
| Last Update Date | 2018-04-24 |