| NPI | 1619274818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 10330553-6004) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 104100000X Social Worker | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-02-24 |
| Last Update Date | 2026-07-09 |