| NPI | 1639867302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 84410) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM CTB-2022-0171) |
| 101YM0800X Counselor, Mental Health (Licence: TX 84410) | |
| Enumeration Date | 2023-05-01 |
| Last Update Date | 2023-09-18 |