| NPI | 1750929121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 89100) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: TX 89100) |
| 101YP2500X Counselor Professional (Licence: KS 3234) | |
| Enumeration Date | 2019-12-17 |
| Last Update Date | 2022-07-28 |