| NPI | 1710140447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 9471022-6044) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 9471002-6004) |
| 101YM0800X Counselor, Mental Health (Licence: ID LPC3887) | |
| 101YM0800X Counselor, Mental Health (Licence: AZ LPC-17502) | |
| 101YP2500X Counselor, Professional (Licence: NV CP3313-R) | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2024-09-10 |