| NPI | 1538331913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 68365696004) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: UT 68365696009) |
| Enumeration Date | 2008-03-26 |
| Last Update Date | 2017-01-09 |