| NPI | 1528813086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 90099) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 131480) |
| 101YP2500X Counselor, Professional (Licence: CO LPC.0022057) | |
| Enumeration Date | 2024-04-18 |
| Last Update Date | 2025-07-23 |