| NPI | 1902399934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: TX 76525) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 76525) |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2022-08-23 |