| NPI | 1750665741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: UT 6384233-6004) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: UT 6384233-6004) |
| 101YM0800X Counselor Mental Health (Licence: UT 6384233-6004) | |
| Enumeration Date | 2011-10-07 |
| Last Update Date | 2018-04-30 |