| NPI | 1912672288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 85924) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 4977) |
| Enumeration Date | 2021-08-10 |
| Last Update Date | 2022-08-30 |