| NPI | 1760762975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 64092) |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2022-12-28 |