| NPI | 1528311032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 10246239-6004) |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 87-0427767) |
| Enumeration Date | 2012-10-22 |
| Last Update Date | 2025-02-11 |