| NPI | 1740423078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: UT 5890613-6004) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: UT 58906136004) |
| Enumeration Date | 2009-04-16 |
| Last Update Date | 2022-07-21 |