| NPI | 1659259703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR R11790) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 98942) |
| Enumeration Date | 2025-08-26 |
| Last Update Date | 2025-08-26 |