| NPI | 1811597172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 79730) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: TX 79730) |
| Enumeration Date | 2020-10-27 |
| Last Update Date | 2024-03-01 |