| NPI | 1679153845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 78863) |
| Enumeration Date | 2021-04-12 |
| Last Update Date | 2021-05-10 |