| NPI | 1689192510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LCPC-10510) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 95566) |
| Enumeration Date | 2017-08-30 |
| Last Update Date | 2025-09-16 |