| NPI | 1750032397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C7683) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 93305) |
| Enumeration Date | 2022-01-14 |
| Last Update Date | 2025-06-20 |