| NPI | 1568635407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TN 2565) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 61480) |
| 101YP2500X Counselor, Professional (Licence: TX 61480) | |
| Enumeration Date | 2008-04-11 |
| Last Update Date | 2022-08-18 |