| NPI | 1659517084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 96560) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MO 2008017425) |
| Enumeration Date | 2009-01-07 |
| Last Update Date | 2025-03-03 |