| NPI | 1700566254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 92146) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MN 3232) |
| 101YP2500X Counselor, Professional (Licence: CO 0023364) | |
| Enumeration Date | 2023-07-19 |
| Last Update Date | 2026-05-09 |