| NPI | 1700640430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 80370) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 80370) |
| 101YM0800X Counselor Mental Health (Licence: TX 80370) | |
| Enumeration Date | 2024-02-13 |
| Last Update Date | 2024-02-13 |