| NPI | 1790809580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP1600X Counselor, Pastoral (Licence: TX Fellow- AAPC) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX LPC- 06880) |
| Enumeration Date | 2007-03-18 |
| Last Update Date | 2025-09-11 |