| NPI | 1588166755 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 75981) | 
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 75981) | 
| Enumeration Date | 2018-03-05 | 
| Last Update Date | 2025-09-18 |