| NPI | 1740627637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 8663702-6004) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 8663702-6010) |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2017-05-09 |