| NPI | 1720798903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OK 11369) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 84907) |
| Enumeration Date | 2022-11-29 |
| Last Update Date | 2024-03-06 |