| NPI | 1851795488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 69891) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 69891) |
| Enumeration Date | 2014-10-10 |
| Last Update Date | 2025-01-06 |