| NPI | 1669931044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: TX 76149) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 76149) |
| Enumeration Date | 2019-03-15 |
| Last Update Date | 2023-09-14 |