| NPI | 1720388077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 73507) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 73507) |
| Enumeration Date | 2010-11-02 |
| Last Update Date | 2026-05-02 |