| NPI | 1619412665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 84270) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 84270) |
| 101YP2500X Counselor, Professional (Licence: OK 10805) | |
| 101YP2500X Counselor, Professional (Licence: LA 9458) | |
| 101YP2500X Counselor, Professional (Licence: MO 2015026792) | |
| Enumeration Date | 2016-12-29 |
| Last Update Date | 2024-04-29 |