| NPI | 1881068609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 10638) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 68525) |
| Enumeration Date | 2015-11-17 |
| Last Update Date | 2021-01-25 |