| NPI | 1700413523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX LPC94424) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA LPCC11325) |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2024-04-01 |