| NPI | 1609495837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 75538) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 202721) |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2020-04-08 |