| NPI | 1790022044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 69361) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM 0145391) |
| Enumeration Date | 2013-01-07 |
| Last Update Date | 2013-07-05 |