| NPI | 1649701426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO .0016541) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 72127) |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2024-09-26 |