| NPI | 1679642615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 15291) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0015189) |
| 101YM0800X Counselor, Mental Health (Licence: AZ LPC18703) | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2023-11-22 |