| NPI | 1619327160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: UT 8746562-6004) |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2023-05-18 |