| NPI | 1730969908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: TX 84970) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 84970) |
| Enumeration Date | 2023-10-04 |
| Last Update Date | 2024-11-02 |