| NPI | 1518428309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 83039) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 251B00000X Case Management | |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2026-04-16 |