| NPI | 1881476257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 91884) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA TEL1019) |
| 101YM0800X Counselor, Mental Health (Licence: FL MH27165) | |
| Enumeration Date | 2023-10-19 |
| Last Update Date | 2026-04-20 |