| NPI | 1730550617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 72322) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SC 2062) |
| 101YM0800X Counselor, Mental Health (Licence: FL TPMC5249) | |
| 101YP2500X Counselor, Professional (Licence: OK 12413) | |
| Enumeration Date | 2015-10-17 |
| Last Update Date | 2026-02-24 |