| NPI | 1881366516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: TX 85042) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 85042) |
| 101YM0800X Counselor Mental Health (Licence: WI 11046-125) | |
| 101YP1600X Counselor Pastoral (Licence: TX 85042) | |
| Enumeration Date | 2021-09-30 |
| Last Update Date | 2024-05-10 |