| NPI | 1619529294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 77470) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NM CTB-2025-0350) |
| 101YM0800X Counselor, Mental Health (Licence: WA MHC.LH.61684480) | |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2026-04-02 |