| NPI | 1619165966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2007010482) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NM CCMH019531) |
| 101YP2500X Counselor, Professional (Licence: SD LPC20998) | |
| 101YP2500X Counselor, Professional (Licence: UT 14251128-6004) | |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2026-03-10 |