| NPI | 1790554061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX 93693) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 93693) |
| 101YP2500X Counselor, Professional (Licence: TX 93693) | |
| 225C00000X Rehabilitation Counselor (Licence: 642432) | |
| Enumeration Date | 2023-12-27 |
| Last Update Date | 2023-12-27 |