| NPI | 1790108983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0013480) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 68176) |
| Enumeration Date | 2014-01-24 |
| Last Update Date | 2022-03-11 |