| NPI | 1568750578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: UT 7350051-6604) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: UT 7350051-6004) |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2023-10-12 |