| NPI | 1871137117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 77051) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 77051) |
| 101YM0800X Counselor, Mental Health (Licence: CO LPC.0018956) | |
| Enumeration Date | 2019-10-30 |
| Last Update Date | 2024-07-06 |