| NPI | 1619189628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: UT 4909154-6004) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 4909154-6004) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2018-10-10 |